Healthcare Provider Details

I. General information

NPI: 1467898262
Provider Name (Legal Business Name): CINDY SUE SYRUS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 BRYANT IRVIN RD N SUITE 200
FORT WORTH TX
76107-7673
US

IV. Provider business mailing address

4637 SUMMER OAKS LN
FORT WORTH TX
76123-4627
US

V. Phone/Fax

Practice location:
  • Phone: 817-738-9866
  • Fax: 817-738-3157
Mailing address:
  • Phone: 817-361-8536
  • Fax: 817-361-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1064251
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: